SB 318 — An Act amending the act of May 17, 1921 (P.L.682, No.284), known as The Insurance Company Law of 1921, in casualty insurance, providing for coverage for postacute neurorehabilitation.

PRINTER'S NO.   252

                     THE GENERAL ASSEMBLY OF PENNSYLVANIA



                        SENATE BILL
                        No. 318
                                               Session of
                                                 2025

     INTRODUCED BY KEARNEY, J. WARD, HUGHES, FONTANA, BROWN, HAYWOOD,
        TARTAGLIONE, COSTA, FARRY, LAUGHLIN AND KANE,
        FEBRUARY 26, 2025

     REFERRED TO BANKING AND INSURANCE, FEBRUARY 26, 2025


                                    AN ACT
 1   Amending the act of May 17, 1921 (P.L.682, No.284), entitled "An
 2      act relating to insurance; amending, revising, and
 3      consolidating the law providing for the incorporation of
 4      insurance companies, and the regulation, supervision, and
 5      protection of home and foreign insurance companies, Lloyds
 6      associations, reciprocal and inter-insurance exchanges, and
 7      fire insurance rating bureaus, and the regulation and
 8      supervision of insurance carried by such companies,
 9      associations, and exchanges, including insurance carried by
10      the State Workmen's Insurance Fund; providing penalties; and
11      repealing existing laws," in casualty insurance, providing
12      for coverage for postacute neurorehabilitation.
13      The General Assembly of the Commonwealth of Pennsylvania
14   hereby enacts as follows:
15      Section 1.    The act of May 17, 1921 (P.L.682, No.284), known
16   as The Insurance Company Law of 1921, is amended by adding a
17   section to read:
18      Section 635.11.    Coverage for Postacute
19   Neurorehabilitation.--(a)    All group or individual health or
20   sickness or accident insurance policies providing hospital or
21   medical/surgical coverage and all group or individual subscriber
22   contracts or certificates issued by any entity subject to 40
 1   Pa.C.S. Ch. 61 (relating to hospital plan corporations) or 63
 2   (relating to professional health services plan corporations),
 3   this act, the act of December 29, 1972 (P.L.1701, No.364), known
 4   as the Health Maintenance Organization Act, or an employe
 5   welfare benefit plan as defined in section 3 of the Employee
 6   Retirement Income Security Act of 1974 (Public Law 93-406, 29
 7   U.S.C. § 1001 et seq.) providing hospital or medical/surgical
 8   coverage shall also provide coverage for postacute
 9   neurorehabilitation for an acquired brain injury. Coverage under
10   this section shall include medically necessary treatment related
11   to or as a result of an acquired brain injury, including
12   cognitive communication therapy, cognitive rehabilitation
13   therapy, neurobehavioral therapy, neurophysiological testing and
14   treatment, neuropsychological testing and treatment, functional
15   rehabilitation therapy, community reintegration services,
16   postacute transitional rehabilitation treatment and day
17   rehabilitation treatment and provide for such services as needed
18   in facility and home and community-based settings.
19      (b)   Prior to payment for postacute neurorehabilitation
20   services, an insurer shall verify that the neurorehabilitation
21   individual practitioners and treatment facilities provide
22   services within the scope of the services provided under a
23   Commission on Accreditation of Rehabilitation Facilities
24   accredited rehabilitation program for brain injury or another
25   nationally recognized accredited rehabilitation program for
26   brain injury and are qualified to provide postacute care
27   rehabilitation services through possession of the appropriate
28   licenses, accreditation, training and experience deemed
29   customary and routine in the trade practice and according to
30   criteria set out in the Office of Long-Term Living's Home and

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 1   Community-Based Community HealthChoices Waiver.
 2      (c)   Coverage under this section may not limit the number of
 3   days of covered postacute care, including any therapy or
 4   treatment or rehabilitation, testing, remediation or other
 5   service described under this section, or the number of days of
 6   covered inpatient care to the extent that the treatment or care
 7   is determined to be medically necessary as a result of and
 8   related to an acquired brain injury. The insured's or enrollee's
 9   treating physician shall determine whether treatment or care is
10   medically necessary for purposes of this paragraph in
11   consultation with the treatment or care provider, the insured or
12   enrollee and, if appropriate, members of the insured's or
13   enrollee's family. Any limitations shall be separately stated by
14   the Insurance Department.
15      (d)   Coverage under this section shall not be subject to any
16   greater deductible, coinsurance, copayments or out-of-pocket
17   limits than any other benefit provided by the Insurance
18   Department.
19      (e)   The Insurance Department shall promulgate rules and
20   regulations that require an insurer to provide adequate training
21   to personnel responsible for preauthorization of coverage or
22   utilization review for services under this section.
23      (f)   This section shall not apply to the following types of
24   policies:
25      (1)   Accident only.
26      (2)   Limited benefit.
27      (3)   Credit.
28      (4)   Dental.
29      (5)   Vision.
30      (6)   Specified disease.

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 1      (7)     Medicare supplement.
 2      (8)     Civilian Health and Medical Program of the Uniformed
 3   Services supplement.
 4      (9)     Long-term care or disability income.
 5      (10)     Workers' compensation.
 6      (11)     Automobile medical payment.
 7      (12)     Fixed indemnity.
 8      (13)     Hospital indemnity.
 9      (g)     As used in this section, the following words and phrases
10   shall have the meanings given to them in this subsection unless
11   the context clearly indicates otherwise:
12      "Acquired brain injury" means an injury to the brain that
13   occurs after birth and can be caused by infectious diseases,
14   metabolic disorders, endocrine disorders or diminished oxygen,
15   brain tumors, toxins, disease that affects the blood supply to
16   the brain, stroke or a traumatic brain injury.
17      "Cognitive communication therapy" means the treatment of
18   problems with communication that have an underlying cause in a
19   cognitive deficit rather than a primary language or speech
20   deficit.
21      "Cognitive rehabilitation therapy" means a process of
22   relearning cognitive skills essential for daily living through
23   the coordinated specialized, integrated therapeutic treatments
24   which are provided in dynamic settings designed for efficient
25   and effective relearning following damage to brain cells or
26   brain chemistry due to brain injury.
27      "Community reintegration services" means incremental guided
28   real-world therapeutic training to develop skills essential for
29   an individual to participate in life to re-enter employment, to
30   go to school and engage in other productive activity, to safely

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 1   live independently and to participate in their community while
 2   avoiding rehospitalization and long-term support needs.
 3      "Day rehabilitation treatment" means a program that provides
 4   assistance with acquisition, retention or improvement in self-
 5   help, socialization and adaptive skills which is accomplished
 6   through comprehensive day rehabilitation programming to acquire
 7   more independent functioning and improved cognition,
 8   communication and life skills.
 9      "Functional rehabilitation therapy" means a structured
10   approach to rehabilitation for brain disorders which emphasizes
11   learning by doing and focuses relearning a specific task in a
12   prescribed format with maximum opportunity for repeated correct
13   practice. Compensatory strategies are developed for those skills
14   which are persistently impaired and individuals are trained on
15   daily implementation.
16      "Neurobehavioral therapy" means a set of medical and
17   therapeutic assessment and treatments focused on behavioral
18   impairments associated with brain disease or injury and the
19   amelioration of such impairments through the development of pro-
20   social behavior.
21      "Neurophysiological testing and treatment" means a set of
22   medical and therapeutic assessment and treatments focused on
23   psychophysiological disorders or physical disorders associated
24   with central nervous system dysfunction.
25      "Neuropsychological testing and treatment" means a set of
26   medical and therapeutic assessment and treatments focused on
27   evaluating the cognitive, emotional, psychosocial and behavioral
28   deficits caused by brain injury.
29      "Preauthorization" means the provision of a reliable
30   representation to a physician or health care provider of whether

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 1   an insurer will pay the physician or health care provider for
 2   proposed medical or health care services if the physician or
 3   health care provider provides the services to the patient for
 4   whom the services are proposed. The term includes
 5   precertification, certification, recertification or any other
 6   activity that involves providing a reliable representation by
 7   the issuer to a physician or health care provider.
 8      "Postacute transitional rehabilitation treatment" means
 9   integrated medical and therapeutic services, treatment,
10   education and skills training within a 24/7 real-world
11   environment of care in a home and community setting.
12      Section 2.   This act shall apply as follows:
13          (1)    For health insurance policies for which either rates
14      or forms are required to be filed with the Federal Government
15      or the Insurance Department, the addition of section 635.11
16      of the act shall apply to any policy for which a form or rate
17      is first filed on or after the effective date of this
18      section.
19          (2)    For health insurance policies for which neither
20      rates nor forms are required to be filed with the Federal
21      Government or the Insurance Department, the addition of
22      section 635.11 of the act shall apply to any policy issued or
23      renewed on or after 180 days after the effective date of this
24      section.
25      Section 3.   This act shall take effect in 60 days.




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